Relationship Between Spine and Spinal Cord when in MRI scanner

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abprops
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March 19, 2014 at 5:13 pm

Post count: 8

#10574

Thank you again Dr Coreman for yet another detailed explanation.
/Users/morris/Pictures/2012-01-09-0007.JPG.pdf/Users/morris/Pictures/2012-01-09-0008.JPG.pdf
I have included photographs taken during the investigative and corrective surgery on the symptomatic pseudomeningocele. One showing the view down through the drained pseudomeningocele and showing the dura. The second showing the larger than expected defect in the dura and the stitches used to close the dura following removal of the schwannoma tumour there years before. The original small defect having expanded considerably due to the regular flow of cerebrospinal fluid.

The pseudomeningocle did indeed have a one way valve preventing back flow of cerebrospinal fluid. Resulting in a build up of pressure within the pseudomeningocel leading to compression of the spinal cord and nausea until that increased pressure dissipated.

Can you point me towards published medical literature which describes the pressure phenomenon similar to spinal canal stenosis?

The MRI imaging shows the pseudomeningocele extending over the combined length of the T9 to T10 vertebra compressing both sides of the dura against the spinal cord and against the anterior wall of the spinal canal. This compression leaving two small areas on either side of the spinal cord to allow cerebrospinal fluid to circulate or flow. The reduced volume of cerebrospinal flow would presumably have caused cerebrospinal fluid stasis. Would the stasis or pressure difference produced be the pressure phenomenon you referred to?

Donald Corenman, MD, DC
Moderator

March 20, 2014 at 12:27 pm

Post count: 8660

#10582

The psuedomeningeocele pressure phenomenon is how this disorder presents. The description can be found in any basic neurosurgical textbook. This fluid filled sac acts like a compressive mass just as any bone spur or herniation would. This compression is how the symptoms occur by reducing blood flow to the cord.

I cannot open your pictures.

The pressure difference is what causes the symptoms. If there was no ball-valve to trap extra CSF into the pseudo sac, there would be no pressure differential and no compression, therefore no symptoms.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

abprops
Member

March 20, 2014 at 8:10 pm

Post count: 8

#10585

Thank you again Dr Coreman.

How can I post copies of the pictures on this website?

I could send them by e-mail but have been unable to do so using your contact section.

Can you provide details of a text book with the explanations?

Donald Corenman, MD, DC
Moderator

March 21, 2014 at 4:48 am

Post count: 8660

#10586

Neurosurgery vols. I-III by Wilkins & Rengachari.
Yeomans Neurological Surgery vols I-IV

Pictures cannot be transmitted yet by this website. You can send images by delivery (DHS, Fedex, UPS) on CD if you choose.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

abprops
Member

March 21, 2014 at 7:32 pm

Post count: 8

#10592

Thanks again Dr Corenman.

I have only been able to have a look at the index list for the two publications so far. And I don’t at this time want to outlay the money to purchase copies, as there is no mention of ball-valves and compression of the spinal cord by a cyst in either index.

However I have found Spinal Disorders: Medical & Surgical Management by J D Barieson & H Gordon Deen, Page 25. Under the Heading Abnormalities that can be congenital or Acquired sub heading Archnoid and perineural cysts. The following info is given:

They can occur at any level in the spine but most occur in the THORACIC REGION, more so POSTERIORILY. They are typically intradural or EXTRAMEDULARY. Many are asymptomatic , BUT THEY CAN CAUSE LOCAL COMPRESSION WITH back pain, radicular pain AND OR MYELOPATHY. Presumably the cysts grow via a BALL-VALVE MECHANISM which TRAPS CSF WITHIN THE CYST. IF SYMPTOMATIC they may require SURGICAL REMOVAL.

The above describes my situation following removal of the intradural schwannoma tumour. The Pseudomeningocele which first appeared on MRI imaging 6 months later as the pseudomeningocel expanded slowly due to the initially small defect in my dura. Possibly assisted by my attempts to regain fitness.

The radiologist report on the second post surgical MRI scan 6 months later noted a slight enlargement of the pseudomeningocel as the effects of surgery on the surrounding tissue reduced. Which seems to confirm that the steady flow of CSF was causing the pseudomeningocele to increase in size and fill the cavity over the back of my spinal canal the neurosurgeon described as a space due to removal of bone and muscle during the laminectonmy to access my dura and remove the tumour. The slow leakage of CSF and growth of the pseudomeningocel being the reason for the delay of over 6 months before I became aware of the symptoms which started to appear within weeks of the first 6 monthly monitoring MRI scan.

I have copies of several international medical publications and case studies which conclude that investigative and corrective surgery is the definitive requirement for the very rare symptomatic pseudomeningoceles. The symptomatic pseudomeningocel that was confirmed by investigative and corrective surgery, to be the cause of my debilitating symptoms three years after the intradural schwannoma tumour was removed. However the above is the first publication I have found which confirms that a cyst connected to a defect in the dura with a ball-valve can result in compression of the spinal cord.

Thanks again for your help Dr Coreman. If you can provide any other references to cysts, ball-valves resulting in spinal cord compression I would be very grateful.

Donald Corenman, MD, DC
Moderator

March 22, 2014 at 2:08 am

Post count: 8660

#10593

I glad you found a source for your disorder. Spine can be thought of in terms that are easy to understand. In your case, this pseudomeningeocele causes compression due to the pressure differences of the normal dura sac and the pseudomeningeocele. Obviously, the pseudomeningeocele with a ball valve will be under higher pressure and that pressure creates a mass effect that compresses the cord.

This compression is not “sharp” like a bone spur would be or a “hard” surface that deforms the cord like a disc herniation would be but still compresses the cord nonetheless. Symptoms are not at severe due to the uniform compression this pseudomeningeocele creates but severe enough to make you miserable.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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